Why Doctors’ Offices Could Become Obsolete

A man showing early signs of a heart attack — detected by a bot tracking his heart activity from a sensor on his wrist — is picked up by a self-driving car that checks his vital signs on the way to the hospital. There, his doctors video-conference with a specialist, who assesses his symptoms through a Skype-like screen and recommends a treatment plan.

The scenario, inconceivable a generation ago, is closer than you might think. Technological advancements are ushering in a new era of health care, eroding the long-held model of hospitals and doctors’ offices as the physical center of the health system. The change is unfolding on many fronts, and experts say we are on the cusp of a revolution that could come within the next decade.

The growth of telemedicine (video chats with your doctor) and tools to track chronic diseases (wearable glucose-monitoring devices for diabetics) is inching us toward a time when medical care and diagnoses can be accessed from afar, and often without having to see a physician in person.

The explosion of relatively inexpensive direct-to-consumer genetic tests is allowing millions of people to learn potentially life-changing medical information about themselves without ever stepping foot in a doctor’s office.

And cutting-edge research in gene therapy is opening the door to the possibility of people with genetic diseases being treated much earlier in life, and being “cured” for longer periods of time — potentially improving the quality of life for millions.

This rapidly changing landscape raises the question: Will there come a day when we won’t need to go to the doctor’s office anymore? Will we be able to navigate the health system without coming into contact with a medical professional? And would that be good or bad?

Developers of self-driving cars are already considering including some basic inward-facing sensors that can be used for medical applications — such as those that can measure temperature or cameras that can visually assess the health of a passenger — to aid the elderly and people with disabilities, according to Nidhi Kalra, senior information scientist at the think tank Rand Corp. who researches autonomous car policy.

Some people “may have health complaints or challenges that the car needs to be aware of as it’s taking them to the mall,” she said.

Kaiser Permanente, one of the largest health systems in Northern California, recently set up a futuristic mock exam room where patients can sit in front of a computer screen to talk to a doctor remotely while using a stethoscope, digital thermometer and otoscope to check their own symptoms under the guidance of the physician. Kaiser CEO Bernard Tyson has personally participated in the experiment.

“That is the future — being able to provide a great health care service without someone having to get up and go all the way across town for that kind of medical visit,” Tyson said. “All these things represent the moving away from the hospital being the centerpiece of health care.”

Last year, 70 million interactions between Kaiser patients and their primary care doctor were done by secure email, video conference and other remote tools.

Worldwide revenue for telehealth devices and services is expected to hit $4.5 billion next year, compared to $441 million in 2013, according to the business analytics firm IHS Technology. During the same period, the number of people using telehealth services each year is projected to grow from 350,000 to 7 million.

“I don’t think we’ll get to a point where we’ll never see a doctor, but a large percentage (of doctors) will be seeing patients remotely” in the future, said Dr. David Tong, director of the telestroke program at California Pacific Medical Center in San Francisco. His program connects his vascular neurology practice with 20 other hospitals from the Oregon border to Visalia, so hospital physicians can seek his help in treating a stroke patient. Tong does a visual assessment of the patients using technology similar to Skype.

Tong has led the program since its inception a decade ago, when just two hospitals were in the telestroke network, and the concept of talking to a doctor through a screen seemed foreign to many patients. Today, it’s commonplace — “People think, ‘If I do this all the time with my friends, I’ll do it with my doctors too. What’s the difference?’” Tong said.

Despite the promise of remote medical care, though, many traditional barriers to health care remain. Wealth, geography and access to insurance are privileges that no app or technological advancement can replace.

“The major stumbling block right now is financial,” said Tong. “Right now, most insurance doesn’t pay for telemedicine in a very efficient way. That blocks some people from doing it.”

Medicare and Medi-Cal, for example, limit their reimbursement for telemedicine services to psychiatry and to patients who live in rural areas, Tong said.

There may also be drawbacks to receiving care remotely, which reduces the need for physical interaction. Studies have shown that human touch reduces stress, helps premature babies grow faster and improves the lives of nursing home residents.

But in another promising development, medicine is also moving in the direction of preventing diseases before they even cause any symptoms. Efforts by genetic testing firms to screen large populations — coupled with research in gene therapy and gene editing — will give people more information than ever before on their genetic makeup.

As soon as five years from now, “everyone who wants to be sequenced will have been sequenced,” said Dr. Jill Hagenkord, chief medical officer at Color Genomics, a Burlingame company that sells a $249 test that analyzes 30 genes associated with common hereditary cancers including breast, ovarian and pancreatic cancer. People can buy the test directly from Color or on Amazon, but they must submit their health information and have a physician review it and order the test before Color will analyze the sample.

“Whether that’s newborn screening in the hospital system or in a research setting … sequencing data will just exist,” Hagenkord said.

Color is already taking steps toward population screening, working with 40 large self-insured employers including Visa and Salesforce — which collectively cover tens of thousands of people — that subsidize or pay for the test for employees and spouses.

Using gene testing as a preventive tool “doesn’t take the medical professional out of the equation, but maybe you’ll just have a conversation earlier with your doctor,” about getting a colonoscopy sooner or making choices that may reduce your risk of certain cancers, Hagenkord said.

Meanwhile, researchers are working to bring gene therapy from the clinical trial stage to the real world to treat retinal disease and hemophilia — though treatments are not yet available commercially, said Dr. Chris Haskell, who leads Bayer Corp.’s West Coast Innovation Center. Bayer has a joint venture with CRISPR Therapeutics — which uses the gene-editing tool known as CRISPR — to develop and market therapeutics for blood disorders, blindness and congenital heart disease.

“With gene therapies, the industry is moving ahead very rapidly in clinical development toward bringing these to patients very soon,” Haskell said. “Gene editing is still a number of years away behind gene therapy, but has promise for being able to treat many more diseases.”

Gene editing is considered a subset of gene therapy. Gene therapy consists of adding a “missing” part of a person’s DNA, typically through an injection of an engineered virus that carries the replacement gene. With the blood-clotting disorder hemophilia A, patients are missing a blood-clotting protein called factor VIII. This protein is injected and, over the course of the next several days or weeks, the cells start producing the clotting factor and allow the circulatory system to clot normally.

“The trailblazing is happening with hemophilia because we understand the disease,” Haskell said. “But there’s a huge promise for bringing therapies to patients around the world, especially kids with metabolic disorders who have no good therapy.”

Gene editing makes it possible to modify the genetic code — and the applications seem limitless.

“This opens up a whole new realm of ways to treat diseases in that we can turn things on and off, take things out,” Haskell said. “With gene therapy, we have the hammer. Now we have the whole toolbox. However, we’re still learning how to use all these tools.”

And the workshop for those tools? It will be anywhere but your old, familiar doctor’s office.